Healthcare Provider Details

I. General information

NPI: 1659047231
Provider Name (Legal Business Name): HANAHAN OP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 EAGLE LANDING BLVD
HANAHAN SC
29410-8517
US

IV. Provider business mailing address

525 CHESTNUT ST STE 102
CEDARHURST NY
11516-2223
US

V. Phone/Fax

Practice location:
  • Phone: 843-553-0656
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL GOLDNER
Title or Position: AUTHORIZED PERSON
Credential:
Phone: 516-727-1634